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Article: Pacing to reduce refractory angina in patients with severe coronary artery disease: A crossover pilot trial

TitlePacing to reduce refractory angina in patients with severe coronary artery disease: A crossover pilot trial
Authors
Issue Date2012
PublisherSpringer New York LLC. The Journal's web site is located at http://www.springer.com/medicine/cardiology/journal/12265
Citation
Journal Of Cardiovascular Translational Research, 2012, v. 5 n. 1, p. 84-91 How to Cite?
AbstractBiventricular pacing (BiV) has been shown to reduce wall stress and workload in regions near the pacing sites. This trial investigated if BiV near the ischemic region would reduce chest pain in patients with refractory angina due to severe coronary artery disease (CAD). Eleven patients were implanted with BiV devices with leads positioned at or adjacent to their ischemic regions as detected by single-photon emission computed tomography (SPECT) and randomized to either pacing turned ON or OFF for 3 months, and then crossed over for 3 months. With pacing turned ON, a Dynamic atrioventricular (AV) delay was set for approximately 90% and 70% of the intrinsic AV delay at the resting heart rate and at the onsetof symptoms, respectively. One patient was excluded from the analysis due to a large amount of RV pacing during the OFF periods (24-64%) and due to an inability to properly deliver therapy because of an excessive number of ventricular premature complexes. Overall, with the device ON vs. OFF, the number of angina episodes (0.8±0.4 vs. 1.2±0.7 per week, P=0.03) and amount of nitroglycerin used (0.2±0.1 vs. 1.0±0.7 per week, P=0.11) was lower with BiV pacing. Furthermore, the treadmill exercise time to symptoms trended higher (427±65 vs. 408±64 s, P= 0.19), and the sum of fluorodeoxyglucose-positron emission tomography (FDG-PET) scores trended lower (7.9±3.5 vs. 12.0±4.0, P=0.11) with the device ON vs. OFF. Nevertheless, there were no significant differences in SPECT myocardial perfusion scores, left ventricle ejection fraction, wall motion score index, and quality of life scores with device programmed ON vs. OFF (all P>0.05). In conclusion, this pilot study demonstrated that BiV-P at or near the ischemic region was feasible and associated with significant reductions in angina in patients with severe CAD. Adequately powered prospective studies are needed to confirm these findings. © Springer Science+Business Media, LLC 2011.
Persistent Identifierhttp://hdl.handle.net/10722/163476
ISSN
2014 Impact Factor: 3.017
2014 SCImago Journal Rankings: 1.171
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorStolen, CMen_US
dc.contributor.authorLam, YMen_US
dc.contributor.authorSiu, CWen_US
dc.contributor.authorLau, CPen_US
dc.contributor.authorParker, JAen_US
dc.contributor.authorHauser, THen_US
dc.contributor.authorTse, HFen_US
dc.date.accessioned2012-09-05T05:31:48Z-
dc.date.available2012-09-05T05:31:48Z-
dc.date.issued2012en_US
dc.identifier.citationJournal Of Cardiovascular Translational Research, 2012, v. 5 n. 1, p. 84-91en_US
dc.identifier.issn1937-5387en_US
dc.identifier.urihttp://hdl.handle.net/10722/163476-
dc.description.abstractBiventricular pacing (BiV) has been shown to reduce wall stress and workload in regions near the pacing sites. This trial investigated if BiV near the ischemic region would reduce chest pain in patients with refractory angina due to severe coronary artery disease (CAD). Eleven patients were implanted with BiV devices with leads positioned at or adjacent to their ischemic regions as detected by single-photon emission computed tomography (SPECT) and randomized to either pacing turned ON or OFF for 3 months, and then crossed over for 3 months. With pacing turned ON, a Dynamic atrioventricular (AV) delay was set for approximately 90% and 70% of the intrinsic AV delay at the resting heart rate and at the onsetof symptoms, respectively. One patient was excluded from the analysis due to a large amount of RV pacing during the OFF periods (24-64%) and due to an inability to properly deliver therapy because of an excessive number of ventricular premature complexes. Overall, with the device ON vs. OFF, the number of angina episodes (0.8±0.4 vs. 1.2±0.7 per week, P=0.03) and amount of nitroglycerin used (0.2±0.1 vs. 1.0±0.7 per week, P=0.11) was lower with BiV pacing. Furthermore, the treadmill exercise time to symptoms trended higher (427±65 vs. 408±64 s, P= 0.19), and the sum of fluorodeoxyglucose-positron emission tomography (FDG-PET) scores trended lower (7.9±3.5 vs. 12.0±4.0, P=0.11) with the device ON vs. OFF. Nevertheless, there were no significant differences in SPECT myocardial perfusion scores, left ventricle ejection fraction, wall motion score index, and quality of life scores with device programmed ON vs. OFF (all P>0.05). In conclusion, this pilot study demonstrated that BiV-P at or near the ischemic region was feasible and associated with significant reductions in angina in patients with severe CAD. Adequately powered prospective studies are needed to confirm these findings. © Springer Science+Business Media, LLC 2011.en_US
dc.languageengen_US
dc.publisherSpringer New York LLC. The Journal's web site is located at http://www.springer.com/medicine/cardiology/journal/12265-
dc.relation.ispartofJournal of Cardiovascular Translational Researchen_US
dc.rightsThe original publication is available at www.springerlink.com-
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshAngina Pectoris - Etiology - Physiopathology - Radionuclide Imaging - Therapyen_US
dc.subject.meshCardiac Resynchronization Therapy - Adverse Effectsen_US
dc.subject.meshCardiac Resynchronization Therapy Devicesen_US
dc.subject.meshCoronary Artery Disease - Complications - Physiopathologyen_US
dc.subject.meshCoronary Circulationen_US
dc.subject.meshCross-Over Studiesen_US
dc.subject.meshEquipment Designen_US
dc.subject.meshExercise Toleranceen_US
dc.subject.meshFeasibility Studiesen_US
dc.subject.meshFemaleen_US
dc.subject.meshFluorodeoxyglucose F18 - Diagnostic Useen_US
dc.subject.meshHong Kongen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshMyocardial Perfusion Imaging - Methodsen_US
dc.subject.meshPilot Projectsen_US
dc.subject.meshPositron-Emission Tomographyen_US
dc.subject.meshPredictive Value Of Testsen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshQuality Of Lifeen_US
dc.subject.meshRadiopharmaceuticals - Diagnostic Useen_US
dc.subject.meshRecovery Of Functionen_US
dc.subject.meshSeverity Of Illness Indexen_US
dc.subject.meshSingle-Blind Methoden_US
dc.subject.meshStroke Volumeen_US
dc.subject.meshTime Factorsen_US
dc.subject.meshTomography, Emission-Computed, Single-Photonen_US
dc.subject.meshTreatment Outcomeen_US
dc.subject.meshVasodilator Agents - Therapeutic Useen_US
dc.subject.meshVentricular Function, Leften_US
dc.titlePacing to reduce refractory angina in patients with severe coronary artery disease: A crossover pilot trialen_US
dc.typeArticleen_US
dc.identifier.emailSiu, CW:cwdsiu@hkucc.hku.hken_US
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_US
dc.identifier.authoritySiu, CW=rp00534en_US
dc.identifier.authorityTse, HF=rp00428en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1007/s12265-011-9326-7en_US
dc.identifier.pmid22038623en_US
dc.identifier.scopuseid_2-s2.0-84859793542en_US
dc.identifier.hkuros201294-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-84859793542&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume5en_US
dc.identifier.issue1en_US
dc.identifier.spage84en_US
dc.identifier.epage91en_US
dc.identifier.isiWOS:000299080900011-
dc.publisher.placeUnited States-
dc.identifier.scopusauthoridStolen, CM=37027318100en_US
dc.identifier.scopusauthoridLam, YM=35316083700en_US
dc.identifier.scopusauthoridSiu, CW=7006550690en_US
dc.identifier.scopusauthoridLau, CP=35275317200en_US
dc.identifier.scopusauthoridParker, JA=35398017100en_US
dc.identifier.scopusauthoridHauser, TH=7006380610en_US
dc.identifier.scopusauthoridTse, HF=7006070805en_US
dc.identifier.citeulike9977632-

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